ZONE:

The number of new HIV cases reported among men who have sex with men in Singapore had almost doubled from 28 in 2000 to 54 (22.3 percent of total cases) in 2003 despite gradual tapering of rates of infection for general population, according to the latest report by Action for AIDS (AfA), Singapore's only HIV/AIDS advocacy group.

According to the advisory, the increase was evident since 1999, with the sharpest rise between 2002 and 2003. The number of officially reported HIV infections among MSM in Singapore jumped from 28 (or 12.4 percent of total cases) in 2002 to 42 (or 16.1 percent) in 2001 and 42 (or 17.9 percent) in the following year.

In 2003, one in four males diagnosed in 2003 were MSM compared to one in seven in 2000. The numbers have sounded the alarm as it suggests that a large number of MSM - despite being a small local gay population - are not practising safe sex, whether with partners, or strangers.

The advisory also reported:

- More cases of newly infected MSM being diagnosed (rather than those with later-stage HIV infection/AIDS) - an indication that there is a significant amount of unsafe sex currently going on.

- More MSM have been infected in Singapore rather than overseas (fewer are reporting overseas sexual encounters as compared to before) - suggesting that HIV prevalence in Singapore is increasing.

- Increasing proportion of younger MSM (below 25) being diagnosed with HIV infection, and they seem more nonchalant about being HIV positive despite the treatment costs, stigma and discrimination that they may face in their personal and working life.

Roger Winder, the Convenor for AfA's MSM HIV/STI Prevention Programme said, "Testing HIV positive is no small matter - you have to cope with trying to keep your HIV status secret (really tough in a small place like Singapore), having enough money to pay for very expensive treatment, worrying about what your regular checkups are going to show about your health, worrying about your health, when it is going to deteriorate and whether it 'shows,' worrying about transmitting HIV to others, worry about relationships, the list goes on."

Some of those who tested HIV positive did not know how to use a condom correctly. From this quarter, MSM volunteers will actively offer HIV/AIDS and safer sex information and advice through chartrooms, e-bulletin boards, e-mail as well as organise sexual health talks and workshops, possibly at MSM venues in the near future.

- Alarming rise in number of MSM diagnosed as HIV positive at the AfA Anonymous HIV Testing Centre. The number of MSM who tested HIV positive at the AfA Anonymous HIV Testing Centre increased from seven in 2000 to 25 in 2003.

The study also reported that projections of the actual number of HIV positive MSM is likely to be three times the reported figure (437 in total so far, including deaths).

Winder highlighted the need for MSM to take precautions with every partner they have. "It cannot be stressed enough - there are a lot more MSM with HIV than the figures indicate, a lot of them unaware of their status. Extra caution is needed in situations when judgement is affected by drugs, alcohol and the availability of many sexual partners."

AfA also reported an increase of the number of STI cases seen among MSM, several of who are bisexual, at the DSC Clinic. The total number of cases including genital/anal warts, gonorrhoea, syphilis and non-gonococcal urethritis (NGU, an inflammation of the urethra that is not caused by gonorrhea) doubled from 83 in 2001 to 163 in 2003.

The MSM committee has also expressed concern "that a continued rise in HIV infection among MSM in Singapore will lead to the authorities closing down MSM establishments (bathhouses in particular, as has been done in the US) and clamping down on MSM activities in general in an effort to control the spread of HIV infection."

It urged the community to take appropriate measures to effectively deal with the spread of HIV and STI among MSM rather than allow the authorities to deal with the situation as they see fit.

Associate Professor Roy Chan, President of AFA urged MSM to educate themselves about HIV and STI, make the practice of safe sex the norm and get tested and treated if they suspect they have been exposed to infection.

He hopes for AfA to galvanise the MSM community to action through an expanded MSM HIV/STI prevention programme which would include the distribution of educational materials, using as many channels in the community as possible, media campaigns, outreach activities, and engaging MSM stakeholders and establishments in these actions.

According to the Health Ministry, the total number of HIV infected Singaporeans as of 31 October 2003 is 2034. Of the total number, 488 have full-blown AIDS and 776 have died. Statistics reveal that of 2034, 1780 are male and of the total number, 252 are reportedly homosexual and 169 bisexual.

. Of these, 770 are asymptomatic carriers, Figures of HIV positive foreigners residing in Singapore are not reported.

Results of 2002/2003 MSM survey

A survey of 1,291 MSM in Singapore conducted by AfA from Nov 02 to Feb 03 also provided a few insights:

- most MSM (41.4 percent) had two-five sexual partners in the previous three months, 20.9 percent had more than five partners.

- the internet was the most common way of acquiring sexual partners (60.6 percent), followed by meeting partners at gay saunas (47.8 percent).

- 29.4 percent had unprotected receptive anal sex, 28.7 percent had unprotected insertive anal sex with 'boyfriends.'

- 14.8 percent had unprotected receptive anal sex, 16.9 percent had unprotected insertive anal sex with casual partners.

- 21.3 percent had had sex while drunk, four percent after consuming recreational drugs, and eight percent after consuming both alcohol and drugs: the last group was more likely to have had unsafe sex.

- 40.4 percent had never been for an HIV test - most of them were unaware about anonymous HIV testing being available.